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physicians available for neuropsychiatric work in the army was limited, and if in some instances the wrong men were selected for the work, or men without sufficient force to withstand the demands which were occasionally made for a merely perfunctory examination, it must be remembered that the surgeon general's office and the War Department were confronted by tasks such as had never confronted this or any other country and that the few points for criticism are far outnumbered by those which deserve unstinted praise.

It has not been alone among those already inducted into service that the psychiatrist has been made available and has done work of great value. The authorities have been fortunate in being able to obtain for many of the local draft boards, and for a considerably larger proportion of the medical advisory boards, physicians with psychiatric training and experience to whom all cases whose mental status was questionable were referred. This has resulted in keeping out of the army many drafted men, who, had they been accepted, would have inevitably been found unfit for service.

There are boards, we are informed, who have been able, because of the assistance rendered them, often at great sacrifice by psychiatrists, to point with some pride to the fact that no soldier inducted into the service after having passed their examination has been rejected because of mental disorder. The field which is still open for psychiatric war work is a large

The so-called war neuroses, the mental disorders arising from disease and injury incident to service, the mental as well as physical reconstruction work, now actively in progress, all present problems of intense interest and importance.

When the medical history of the war is written it is to be hoped that a competent psychiatrist will, with ample assistance and free access to the records, be one of the many who will necessarily be engaged in the task.

The medical department of the army in pre-war days sent an occasional medical officer from the army medical corps to Washington and perhaps elsewhere for a brief course in practical psychiatry. Surely recent experience has taught that as far as possible every army and navy medical officer should have not only one, but repeated periods, at intervals, of service in the wards of hospitals for mental disorders.

There are now numerous hospitals whose medical service and laboratory facilities are such that adequate post-graduate training in psychiatry can be furnished to the army medical men, and where such men would receive a hearty welcome.

THE INSTITUTIONAL CARE OF THE INSANE IN THE UNITED STATES AND CANADA.—This work, which was undertaken under the patronage and endorsement of the American Medico-Psychological Association, has been reviewed in the pages of this JOURNAL as the several volumes have appeared.

It comprises four volumes of 497, 997, 880 and 605 pages, respectively, with an index of 45 pages.

The work gives as complete a history as is possible at this time of the care of the insane in the United States and Canada, and of the organization and construction of institutions for the mentally disordered. The review of the proceedings of the Association of Superintendents of American Institutions for the Insane, known for the past 26 years as the American Medico-Psychological Association, presents in a brief compass the history of the progress of psychiatric medicine in America for three-quarters of a century nearly.

The steps taken by different states to care for the indigent insane, the conduct and government of institutions in different communities are all spread before the student of the history of medicine in a wealth of detail which is alluring.

Dr. Hurd and his collaborators have placed the medical profession, and particularly the Medico-Psychological Association, under a great debt to them. The work should be found in every public library and library of reference and especially in the library of every institution for mental disorders in the United States and Canada.

Every known institution at the time the work was written finds mention in these volumes. If in some instances the details are few, it is either owing to the fact that no accurate data were in existence or to the carelessness or indifference of those in charge, in furnishing historical and other material.

There are to our knowledge several hospitals from which no subscriptions for the volumes have been received and many physicians who have not taken the opportunity to subscribe. We urge upon all such the wisdom of at once writing to the Johns Hopkins Press, The Johns Hopkins University, Baltimore, and inclosing an order for the volumes. No institution can afford to be without this valuable historical work; no progressive psychiatrist will fail to have it in his library.


Book Reviews.



Problems of Subnormality. By J. E. WALLACE WALLIN, Yonkers-on

Hudson. (World Book Co., 1917.) This book of some five hundred pages is a discussion of the problems of subnormality from the standpoints of differential diagnosis and differentiated educational and industrial treatment, beginning with school organization and carried on by the community, city or state according to systems of after-care and supervision outlined by the writer. The opening chapter on “Changing Attitudes Toward the Subnormal” gives an historical résumé, which makes a fitting background for the main thesis.

From the angle of differential diagnosis, or “Who is Feeble-minded,” the writer believes that “the fundamental weakness in the organization of special classes in the public schools has been the lack of definiteness in the selection of the candidates for these classes.” In support of this premise he brings a formidable amount of data not only from public school reports in various parts of the United States, but also reports from industrial schools, institutions for delinquents, psycho-educational clinics connected with universities, etc., to show that general confusion reigns in these circles as to who is “normal,” “retarded," " backward," " borderline,"

," "undetermined ” and “ feeble-minded.” The causes of this deplorable state of affairs are: (1) A too arbitrary use of the Binet-Simon scale as a quantitative standard for determining the intelligence level; (2) The use of this psychological function test by “amateurs.” “ Large numbers of social and psychological workers are being appointed as 'experts' on feeble-mindedness in the schools, courts, and clinics throughout the country. Unfortunately many of these so-called 'psychologists' are young teachers just out of the normal school; some are grade teachers working with subnormal children, who have learned to give the B.-S. (Binet-Simon) or other tests; some have had a college course, but possess practically no training in scientific research, possess little or no clinical training or experience, and have no technical acquaintance with psychopathic anomalies, although they may have spent a few weeks in an institution and have read some of the texts; some are social workers who are not versed in the technical procedures of any of the psychological or medical sciences but who may have spent some time in an institution and who can work by rule-of-thumb with the B.-S. scale."

As therapeutics for the above, Dr. Wallin would have us always bear in mind that Binet and Simon merely offered a tentative pedagogical basis for the preliminary selection of candidates for special classes"; he would also have suspected individuals examined by two different specialists, by "a physician, with clinical experience, not only in the general field of medicine, but in neurology and psychiatry, and a psychologist, with not only a technical acquaintance with all aspects of elementary, industrial, and corrective pedagogy but with adequate clinical experience with the fundamental types and the different grades of mental deficiency, from a slight degree of retardation to profound idiocy."

With an adoption of saner attitudes towards the determination of subnormal individuals the writer turns attention to organized efforts in the way of public school training and after-guidance. He has again taken great pains to collect data by means of questionnaires and statistical reports as to what is actually being done in different parts of the country in the way of special and ungraded classes in public and industrial schools

. By way of criticism he feels that too little attention is paid by school systems to the needs of the individual child especially with reference to vocational guidance and control during the years that follow the child's school life. He recommends: "(1) The making of vocational surveys of employments available in the community which fit the vocational capacities of feeble-minded children but which, at the same time, are not surrounded by social conditions which impose too great a strain on the weak moral natures of the feeble-minded. (2) The placement of children in positions suited to their limitations, and rendering them such assistance and encouragement as will tend to keep them permanently employed. (3) Advising with employers for the purpose of explaining the child's limitations, so that work fitting his level of functioning may be assigned him, and that he may receive more lenient and sympathetic treatment. (4) Protecting the children so far as possible from moral and economic exploitation, and safeguarding them from criminalistic careers when the parents fail adequately so to do."

Although somewhat ponderous in the compass of material and tedious in the wealth of statistical detail, this book rings true in its plea for a more thorough study of the individual child as a whole; for less contention over the nomenclature of the “special child” and more attention to his peculiar needs; for a direction of the child's school years in better harmony with the place he is able to take in the community after leaving school. Those of us who have seen the Binet-Simon scale applied in all innocence and good faith to an outspokenly psychotic adult can forgive Dr. Wallin for the asperity with which he decries the “army of amateurs ” who pass on the mental states of individuals merely by following “the rule-of-thumb procedure” involved in the use of this test. Such a frank recognition of the limitations of this and other tests for measuring the intellectual capacity of a human being is as gratifying as it is unique from the pen of a psychologist.

E. L. R.

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